Page 61 - 2023 SMOG Digital

Environmental

HYPERTHERMIA

Signs and Symptoms: Differential Diagnosis:
• Altered Mental Status • Infection • Heat Exhaustion
• Loss of Consciousness • Dehydration • Heat Stroke
• Hot/Dry or Sweaty Skin • Thyroid Storm • CNS Lesions or
• Hypotension or Shock • Medications/Toxin Tumors
• Seizure • Delirium Tremens
• Nausea/Vomiting • Heat Cramps

Universal Patient Care Guideline
Continued from: O2 (if Hypoxemic)
Tactical Evacuation Guideline IV/IO Guideline
Cardiac Monitor (ASAP)
Altered Mental Status and Remove from Heat Source Altered Mental Status
with
Temperature >40ºC/104ºF Loosen / Remove Clothing Temperature <40ºC/104ºF
Consider Intubation: Assessment: Consider Intubation:
AIRWAY Guideline • Mental Status AIRWAY Guideline
• Rectal Temperature
• Glucose (treat per AMS Guideline)
Aggressive cooling: 1L IVF Bolus/PO fluids
• Tepid water to skin with fanning A Altered Mental Status and d
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• Ice packs to groin/axillae/neck T Temperature >40ºC/104ºF º F Tepid Water or Room Temp
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• Consider opening windows Saline to Skin
D/C once temp ≤40ºC/104ºF!!! 1L IVF Bolus or PO fluids Altered Mental Status
Guideline
(prevents rebound hypothermia)
Be prepared for and consider:
Consider benzodiazepines to • PO fluids as able Seizure Guideline
block/stop shivering of rebound Consider:
Hypothermia: • Tepid Water or Room Monitor EKG for Arrhythmia
Midazolam 0.1mg/kg Temp Saline to Skin (treat per appropriate guideline) ENVIRONMENTAL
Monitor EKG for Arrhythmia
(treat per appropriate guideline) Continuous Monitoring/ Arrhythmia?
Reassess
Be prepared for and consider:
Seizure Guideline NO When appropriate, return to: Bradycardia Tachycardia
with Pulse
with Pulse
Tactical Evacuation Guideline
1L IVF Bolus/PO fluids Cardiac Arrest
Altered Mental Status (VF/Pulseless VT or
Altered Mental Status? YES Guideline Asystole/PEA)
Pearls:
• The single best method to cool patient is sublimation-sprinkling with water and fanning to evaporate off the skin
• Groups at elevated risk for heat emergencies: elderly, very young, highly active.
• Use of alcohol, cyclic antidepressants, phenothiazines, and anticholinergic medications increase risk.
• Cocaine, ecstasy, amphetamines, and aspirin toxicity can all raise body temperature.
• Sweating does not exclude heat stroke/heat illness.
• In conscious patients that can protect their airway, encourage intake of PO fluids and electrolytes.

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